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10 th Common Review Mission- Himachal Pradesh 4th November -11th November 2016

10 th Common Review Mission- Himachal Pradesh 4th November -11th November 2016. Strengths. Institutionalisation of ASHA Programme and good progress on the training Functional 108 Services through a dedicated control room Visible impact of Kayakalp Initiative

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10 th Common Review Mission- Himachal Pradesh 4th November -11th November 2016

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  1. 10th Common Review Mission- Himachal Pradesh4th November -11th November 2016

  2. Strengths • Institutionalisation of ASHA Programme and good progress on the training • Functional 108 Services through a dedicated control room • Visible impact of Kayakalp Initiative • Good availability of 56 essentials medicines and 10 Consumables • Empanelment of a reputed laboratory for Emergency Lab. Services 24X7 • CT Scan facilities under PPP at both DHs and selected FRUs • Implementation of PFMS for the DBT • Smooth and timely transfer of funds from State Treasury to the SHS, Districts & Blocks

  3. Innovations & Best Practices • Birth Waiting Homes - Accommodation and food for pregnant women and attendants while awaiting delivery • SURAKSHA- Community based Advanced distribution of Misoprostol to prevent PPH • Interventions like Mukhyamantri State Healthcare Scheme, ACS registry, Tele-stroke project & Dialysis Centres (PPP),

  4. Concerns • Skewed distribution of functional health facilities • HR issues to be addressed on priority • Non-utilization of assets like X-ray machines and Physiotherapy equipment at few facilities • Delay in the JSY Beneficiary payments especially in the case of Gramin Bank and Cooperative Banks (Non-core Branches) • Sub-optimal efforts for Quality Certification of Health Facilities • Non-deduction of TDS on salary and vendor payments

  5. Recommendations • Operationalization of FRUs in Remote locations • ‘Paradigm shift’ in planning from Population norm to ‘time-to-care’ norm • Inclusion of Industrial area under NUHM • Provision for ASHA waiting Room • Utilization of funds under NCD Programs and Communicable disease needed improvement • Utilization of available QA HR for Quality Improvement and Certification of Health Facilities

  6. Action taken by state

  7. Shortage of HR to deliver committed services • Non-utilization of asset like X-ray machines and Physiotherapy equipment due to non-availability of qualified HR • Presently 200 MBBS per annum • 3 new medical colleges in last 2 years • State will have 500 MBBS per annum in next 4-5 years • More than 200 post graduates per annum • 1000 posts of paramedics approved recently

  8. Skewed distribution of Healthcare institutions Non-provision of full JSSK benefits at all facilities, e.g. Diet • Adequate number of institutions as per population norms • Sometimes institutions not strategically placed • Due to geographical reasons • Other constrains • In bigger hospitals free diet to all indoor patients • Including pregnant women • NGOs and Voluntary organizations also pitch in • In smaller institutions like PHC • Caters to less than 3% of indoor load • Viability for vendor not there due to low load

  9. Non-selection of Kayakalp PHC in each District • At the time of CRM visit • Only PHCs of 6 districts had been assessed & nominated • Subsequently GoI extended the timeline • PHCs of 5 more districts qualified • PHCs of District lahaul & Spiti could not be assessed due to snow • Implementation of Revised BMW Rules 2016 yet to start • Implemented in December, 2016

  10. Non-deduction of TDS on salary and vendor payments • Comprehensive instructions to concerned issued(Copy attached) • Implementation being reviewed in zonal meetings • Delay in the JSY Beneficiary payments especially through Gramin Bank and Cooperative Banks (Non-core branches) • Both the banks are still pending to be integrated with the PFMS portal • Gramin Bank • Meeting held with MD & Chairman • Integration by 30th June • Four Cooperative banks and Post office • Integration within 3 months

  11. Inclusion of Industrial Areas under NUHM – Baddi, Nalagarh, Barotiwala etc. In view of topography of the state, ‘Paradigm shift’ in planning from Population norm to ‘time-to-care’ norm for establishing Urban Health Facilities. • Said areas included under NUHM • 9 ANMs giving services • Mahila Arogya Samities have been formed in these areas • Health institutions • CHC Nalagarh, CHC Baddi, ESI Baddi & PHC Barotiwala • All institutions are within ½ Hour reach of population • ASHA Waiting Room by the name of ‘ASHA Griha’ is being made in the MCH wing at KNH • Plan to establish similar facilities in upcoming MCH wings • Gradually in other high load facilities • Budget from NHM • Provision for ASHA waiting Room

  12. Utilization of funds under NCD Programs and Communicable disease needs to be improved • DCPs • Against approval of 1592 lac only 752 Lac received • 100% expenditure • NCD • 11 Cancer care units made functional • Expenditure being booked • Engaging Pollution Control Board for workable solutions – Liquid Waste & ‘Hard to reach’ facilities. • Pollution control board involved in all district workshops • 14 effluent treatment plants for will be made functional in consultation with Pollution Control Board • All health facilities mapped • Pollution Control Board to locate their incinerators at strategic locations

  13. Utilization of available QA HR for Quality Improvement and Certification of Health Facilities • QA HR actively involved • Responsible for implementation of Kayakalp programme • Trainings under quality assurance • Assessment process • Quality of care package suggested by State Health Commission • Quality consultants of these districts are being trained as mentor and coaches • Various activities for implementation of BMW Rule 2016 like Procurement of BMW bins & liners, trainings and immunization of staff are not initiated yet • Trainings in BMW Rule 2016 completed • Health functionaries given 1st & 2nd dose against Hepatitis –B • Steps taken to identify gaps in procurement • Procurement of BMW bins and liners is going on

  14. Ensure regular DLVMC meetings for all districts IFA supplementation not started for children below 10 years due to procurement challenge (State requested that ministry directive for rate contract finalized by other States) • 7 meetings held • Una-3, Kinnaur-2, Mandi-1 and Kangra-1 • Hon’ble M.P. is the chairperson for DLVMC meeting • 4 MPs and 12 districts • Issue taken up with the Government of India. • Request submitted to GoI for permission to adopt Rate Contract of Centre/other states

  15. Thank you

  16. Thanks

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